The many faces of addiction
by Anthony Kelly
The multifaceted issue of addiction has its roots in external social, environmental and economic pressures as well as in internal strife, such as spiritual emptiness, a loss of meaning, disconnection from self and others, and the resultant low self-worth, pain, anxiety and depression. Over the years there have been many different theories and lenses deployed to understand and treat addictions. Earlier models of approach such as the moral, disease, social and chemical dependency theories all brought their own unique perspectives, ideas, strengths and failings to bear on understanding the true nature of addiction. Currently we have moved towards a biopsychosocial-spiritual model of understanding which acknowledges addiction as a psychological, biochemical, spiritual and social disorder; thus unifying previous models of understanding into a comprehensive and holistic approach.
The biopsychosocial-spiritual model is proving a very useful lens for our understanding of the nature of addiction and I will give it some time here before introducing addiction’s sources, be they pre-natal, developmental, biological, familial or spiritual. I will touch on the topic of denial, as it of course has powerful implications for the maintenance of addictive behaviours. I will also describe a tri-phasic approach to treating addiction, namely to stop, to engage in depth-psychotherapy and finally to invest in a process of resocialisation. I will also discuss motivational interviewing as it has an important role in this approach, aiding in promoting personal responsibility, maturation and efficacy, setting goals and developing discrepancy between current behaviour and desired future outcomes.
The biopsychosocial-spiritual model
To explore the full nature of addiction we cannot separate a person from their environment, nor the spirit and mind from the body. Addiction is a complex issue with many moving parts, requiring a holistic approach, therefore we seek out a comprehensive theory in the form of the biopsychosocial-spiritual model; and it is of great benefit for the therapist in holding an awareness of the internal and external factors which contribute to addiction, as well as its implications for the social and familial systems the client exists within.
The biopsychosocial-spiritual model allows a therapist to take a wide-angle view which encompasses pre-natal, attachment, traumatisation, family systems and other developmental issues. In addition to this it does not lose sight of the essential biological factors such as neurobiological and organic changes. It also circumscribes the significant nature of spiritual deficiencies such as living in a state of disconnection, within an existential vacuum and with a profound loss of meaning.
All of this knowledge provides the therapist with essential maps towards understanding the source of a client’s suffering. This wider lens can also bring objectivity to a therapeutic encounter, allowing the therapist to maintain an open, accepting and non-judgmental stance and lessening the potential for damaging judgements, projections or countertransferences on the therapist’s part.
The sources of addiction
It is essential for a therapist to understand that at the root of any addiction there is discomfort, pain, abject fear, low self-worth, emptiness and a profound disconnection from self and source. This felt sense of spiritual hollowness and an experience of the self as worthless and wretched can occur as a result of pre-natal and peri-natal trauma and neglect. This is particularly true when intra-uterine emotional and physical distress pushes us beyond the boundaries of transmarginal stress and into paradoxical reactions.
Discontinuous reactions do occur when uniform stress is kept up at traumatic levels. The longing for life switches dramatically into a death-wish… The effect of these paradoxical reversals of response to the same stimulus is to produce in the same personality, extremely contrary behaviour.
Lake (1986): 10-11
According to Lake we can see that transmarginal stress indeed occurs when we find ourselves pressed beyond our capacity for suffering to the degree that our desire for life is replaced by a wish for death. Beyond this point we begin to undergo paradoxical reactions such as experiencing pleasure as pain, or finding comfort in painful experiences.
Brain development in the uterus and during childhood is the single most important biological factor in determining whether or not a person will be predisposed to substance dependence and to addictive behaviours of any sort, whether drug related or not.
Mate (2008): 180
Ruptures in early childhood attachment can also give rise to the development of an ingrained negative self-concept, a deep sense of emptiness and worthlessness, difficulty in establishing meaningful relationships and a higher base level of stress throughout life. Profoundly traumatic experiences in later life can also contribute to a free-floating mass of stress and fear in the form of un-integrated or ‘frozen’ experiences that again contribute to a higher baseline of stress; with a healthy intra-uterine experience and the development of secure attachment in childhood conversely helping to inoculate an individual against later troubles.
Children who suffer disruptions in their attachment relationships will not have the same biochemical milieu in their brains as their well-attached and well-nurtured peers. As a result their experiences and interpretations of their environment and their responses to it, will be less flexible, less adaptive and less conducive to health and maturity.
Mate (2008): 192
These feelings of spiritual emptiness, fear and negative self-worth generate a deep yearning hunger for completeness and relief from stress and pain that substances and addictive behaviours offer a means to briefly soothe.
As these longings (for wholeness) emerge into a fuller recognition, and without the capacity to meet them in healthy pursuits they may be revealed in and/or projected onto and quieted with mood altering substances and activities, with overindulgence resulting in addiction.
Russell (2004): 18-19
In understanding these dynamics, a therapist has the opportunity to foster healthy attachment and assist a client in abreacting and integrating traumatic events.
Addiction is a progressive illness, and as time goes on neurostructural changes occur; when these changes in the dopamine and opioid systems (responsible for motivation and attachment), as well as damage to areas responsible for impulse control and executive functioning take place, this reinforces addictive responses and limits an addict’s personal agency at a fundamental level.
In short, drug use temporarily changes the brain’s internal environment. The “high” is produced by means of a rapid chemical shift. There are also long-term consequences: chronic drug use remodels the brain’s chemical structure, its anatomy and its physiological functioning. It even alters the way the genes act in the nuclei of brain cells.
Mate (2008): 146
A family impact
When we apply a wider social lens to the plight of addiction it also becomes obvious that one person’s struggle with addiction is not limited in effect to that individual alone. It is borne of, and impacts upon, their wider relational and social networks. Close relationships and those within a family system may be put under intense strain; over time this strain can alter relational dynamics within a family system as it seeks stasis.
Family members may become complicit in patterns of enabling, denial, secrecy, and co- dependency as a way of containing damage, maintaining family cohesion and projecting an outward image of normality to avoid embarrassment. In adopting various styles of managing addiction(s) within the family system, family members may develop rigid roles, coping patterns and defences that limit their ability to adapt and respond to their own challenges in life. Potential addictive behaviour may arise later as a maladaptive response to trauma caused by early encounters with an addicted caregiver or parent, in a self-perpetuating cycle that can be handed down transgenerationally.
The addictive personality is a personality that hasn’t matured. When we come to address healing, a key question will be how to promote maturity in ourselves or in others whose early environment sabotaged healthy emotional growth.
Mate (2008): 228
With this in mind it can be of great benefit for the therapeutic relationship and the family at large if the therapist assists his client in exploring what forms of addiction may be present in their own family system, what roles they might have adapted in response to that environment, and what feelings they are carrying about themselves, their relationships and the world at large as a result of those experiences. This allows the individual to differentiate from the family system, see themselves in a new light, relieve themselves of the misplaced guilt and shame that may have been placed upon them, and to make new decisions coming from a more mature, empowered place of personal being and wellbeing that exists beyond the pain, the roles, and the addictions which previously had held them in their thrall.
The role of denial
A therapist must also be aware that defence mechanisms play an extremely important role in addiction, denial being the most common defence associated with addictive behaviours. Denial allows us to shield ourselves from personal responsibility for the actions we have taken when intoxicated, or in pursuit of our addicted desires. It helps us to maintain a positive self-image by displacing difficult feelings of guilt, shame, grief and anger. At the same time denial also distances us from ourselves and from the reality of a dire situation perpetuated by our addictive behaviours. We can blind ourselves to the depths of our problems, lie to ourselves about how much control we have over our addictions, and this ultimately results in a failure to recognise the extent of the consequences created by our addicted way of being, even as our life, relationships and our health fall to pieces around us.
As the addictive process continues, addicts become compulsively harnessed to the object of their addiction as well as to the destructive and self-destructive behaviour implicit on it. Increasingly fortified by a misleading denial system, they continue engaging in addictive activity in spite of increasingly harmful consequences.
Grof (1994): 142
So rather than face into the truth of our situation we may rationalise and minimise our behaviours, intellectualise our actions or misattribute and project blame on to those around us, disowning our responsibilities and ceding personal control as we continue on a downward arc. It is an essential part of the therapeutic process then for these defences to be carefully challenged and removed; this should be done in such a way that avoids argumentation and does not create further feelings of guilt and shame, which would naturally raise defences and be counterproductive.
As denial dissipates, and clarity returns, we then may reflect accurately on our situation making a fearless and searching moral inventory. We can see things truthfully and this allows us the capacity to regain control of our lives, by taking personal responsibility for developing new resources and making fresh and informed decisions about who we are and who we want to be.
A tri-phasic treatment
The treatment of addiction takes a tri-phasic approach; stopping, depth-psychotherapy and resocialisation. As addiction is a primary illness which blocks treatment of other issues, the addicted person first needs to stop their addictive behaviours. If gentle persuasion does not succeed, then an intervention may be required. The role of an intervention is to motivate a dependent person to accept professional help. It is carried out by those closest to the person. It is a non-judgemental confrontation using strong persuasion. Sometimes an intervention takes advantage of a crisis like the loss of a job, marriage or another meaningful relationship to overwhelm the wall of denial and self-deception which is keeping a person from seeing the damage being caused by their addictive behaviours. It is a professionally prepared, pre- arranged situation, consisting of prompt and decisive action carried out when the individual is sober, by people meaningful to the dependent person and who are genuinely concerned for their wellbeing.
Once the addicted person has stopped and is ready to engage in the second phase, depth- psychotherapy, the therapist may employ Frank Lake’s Dynamic Life Cycle as a model of understanding.
The Dynamic Life Cycle is a four phase model of personality which indicates the direction towards healthy personality formation and functioning. It consists of two initial input phases, acceptance and sustenance, in which we ideally have our needs met so as to establish a healthy sense of being and wellbeing. These inner resources are then expressed in a healthy way during the two output phases of motivation and achievement; once our energy is expended we may then return to the restorative input phases.
Trouble occurs when there is frustration and disruption, particularly at the input phases. For instance, let’s take phase one acceptance. Frank Lake suggests that in our intrauterine life we establish our sense of being in relation to our mother and acceptance is the key component in this. If there is disruption and pain at this point, either because we are unwanted, unaccepted and unloved, or perhaps because our mother suffered some kind of trauma or illness, we are affected through the placental umbilical connection and our sense of being may be compromised, creating a deep primal wounding that exists beyond cognitive memory. Blocking and frustration during the second phase of sustenance generally refers to unmet needs for recognition, love and attunement in infancy and early childhood and may, for example, present as problems with attachment.
By taking this model into account a therapist may observe frustration or blocking at the input phases of acceptance and sustenance of personality, resulting in an undeveloped/ absent sense of being or wellbeing. Unable to hold a solid sense of status or worth within themselves, a client may instead have resorted to seeking a fleeting feeling of restoration, wholeness or refuge from pain through maladaptive and addictive responses.
Their existential fears and insecurities and their personal pain, shame, unworthiness, is experienced as sometimes unbearable. The drive to transcend the pain is patterned into a response of control and pre-emption; a seeking of solace and respite through drugs and alcohol and other addictive pursuits.
Russell (2004): 20
Through the use of reflection and Motivational Interviewing techniques a therapist can actively help their client to develop choices, decrease the desirability of the addictive substances and behaviours, clarify present and future goals, and develop discrepancies between current behaviours and these goals by way of motivating a client towards self- directed change.
Along with abstinence, the goal is spiritual and emotional growth and, by utilising the broad knowledge base outlined above, a skilled therapist can resource a client through a relationship of loving, empathic acceptance to seek out the truth at the heart of their addictions, to let go of their attachment to damaging substances and behaviours, to mourn the loss of this attachment and move on.
Freedom from addiction means much more than just recovery of a former state of health. It means also the experience of growth. In the whole person, growth is an action involving change of feeling and attitude towards oneself and others, an action amounting to a way of life, a practical philosophy applied to one’s behaviour from day to day.
O’ Connor (2012): 14
In the final phase of resocialisation, the client is then free to reinvest their energy back into life and to find a space within to nurture meaning, hope and purpose, resourcing their sense of being and wellbeing, achieving an inner sense of status and the embodied knowledge that they are acceptable, lovable and loved.
When a person has finally come to this place of maturity, inner acceptance and freedom from their addictions, their therapist can support them in the maintenance of this newfound freedom by helping clarify and implement practical strategies to avoid social, environmental and situational triggers associated with their previous addictive behaviours, and suggesting fellowships such as Alcoholics/Narcotics Anonymous as instrumental peer supports in the prevention of relapse.
Addiction has many elements that need to be taken into account for effective treatment, for this reason we can see the need for a comprehensive model of understanding such as the biopsychosocial-spiritual model. We can also see the need for a therapist to hold a broad knowledge base in reference to the many sources of addiction, so as to be able to resource and support a client through their exploration of any pre-natal, developmental, biological, familial, and spiritual issues that do arise within a therapeutic relationship that deals with addiction. The impact addiction has on a family system and its members is clear, and so too is its potential for continuing down through generations of the same family by means of ruptured attachments, developmental traumas, rigid roles, secrets and shame. We have seen too, the implications of denial, whether that is individual, familial or societal in keeping us blind to the consequences of our addictions.
Finally, we can see how through a tri-phasic treatment plan and an accepting, empathic therapeutic relationship, a person can find the inner capacities of meaning, self-worth and hope needed to grow beyond the shackles of their addictions.
Anthony Kelly is in his third year of training in Humanistic and Integrative Psychotherapy at The Castlebar Counselling and Psychotherapy Centre, Breaffy, County Mayo.
Grof, C. (1994). The thirst for wholeness. New York: Harper Collins.
Lake, F. (1986). The dynamic life cycle: Introduction to the model. London: Clinical Theology Association.
Mate, G. (2008). In the realm of the hungry ghosts. Toronto: Random House.
O’Connor, J. (2012). An article by John O’Connor who is in his 45th year of sobriety. The Journal of the Irish Association of Alcohol and Addiction Counsellors, Summer 2012, 14-17.
Russell, M. (2004). The spiritual dimension in addiction. Eisteach, 4(1), 18-20.